Dr. Andrew Jacono On The Minimal Access Deep-Plane Extended Facelift

Traditional facelifts pull skin taut across underlying tissue, creating tension that telegraphs the surgery. Dr. Andrew Jacono introduced a different approach in the early 2000s that rebuilds facial architecture from deeper layers, producing results that can last years while using incisions one-third the length of conventional techniques.

The Minimal Access Deep-Plane Extended (MADE) facelift moves skin, muscle, and fat as a unified structure rather than separating layers. This biomechanical difference eliminates the stretched appearance that marks older facelift methods. Dr. Andrew Jacono first published his technique in Aesthetic Surgery Journal in 2011, documenting outcomes in 153 patients.

The New York facial plastic surgeon performs approximately 250 extended deep-plane facelifts annually at his Manhattan practice. Volume creates expertise. Repetition refines judgment about which facial ligaments to release, which vectors produce optimal lift, and where natural facial contours lie.

How Technique Differs From Conventional Approaches

Standard facelifts separate skin from the superficial musculoaponeurotic system (SMAS), then pull the skin upward and backward. The approach tightens surface tissue but leaves deeper facial structures unchanged. Results typically last six to eight years before gravity reasserts itself.

Dr. Andrew Jacono’s extended deep-plane method operates beneath the SMAS layer. Town & Country noted that “Jacono keeps the skin, muscle, and fat as one unit” when repositioning tissue. He releases four key facial ligaments that anchor tissue to bone, allowing vertical repositioning of descended fat pads in the midface, jawline, and neck.

The technique addresses aging at its anatomical source. Faces age through volume loss and downward tissue migration, not just through skin laxity. Lifting deeper structures provides foundational support that surface tightening cannot achieve.

Incisions measure roughly one-third the length of traditional facelifts, hidden behind the ear and along the hairline. Patients can wear their hair up without visible scarring, hence Dr. Andrew Jacono’s description of the procedure as “ponytail-friendly.”

Clinical Outcomes and Longevity

Initial clinical data showed a 3.9% revision rate, approximately 1.9% hematoma rate, and 1.3% temporary facial nerve injury. These complication rates fall below industry averages for facelift procedures. Later studies confirmed that deep-plane techniques carry lower facial nerve injury risk than superficial approaches because dissection preserves anatomical relationships and blood supply.

Key factors affecting the longevity of the extended deep-plane facelift include technique, lifestyle, skin quality, and care. The approach can last roughly twice as long as standard SMAS facelifts due to deeper tissue support and durability. Patients maintain results for over a decade in many cases, with some extending beyond 12 years.

Dr. Andrew Jacono published a 2019 refinement introducing additional modifications for jawline rejuvenation and volume enhancement in the lower face. He documented these advances in medical literature, providing quantitative evidence through measurements like the “mandibular defining line” that tracks jawline contour improvements.

Fashion designer Marc Jacobs publicly discussed his facelift with Dr. Andrew Jacono in 2021, telling Vogue the results looked natural without appearing “done.” Even plastic surgeon Dr. Paul Nassif traveled from Beverly Hills to New York for Jacono’s extended deep-plane technique.

The dual board-certified facial plastic surgeon has delivered master lectures at over 100 international conferences, teaching the methodology to surgeons worldwide. His 2021 medical textbook synthesized insights from over 2,000 facelift procedures, establishing technical standards other surgeons now follow. What began as one surgeon’s innovation has become a widely adopted approach that changed how facial plastic surgery addresses structural aging.